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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 14  |  Issue : 3  |  Page : 126-129

Effects of adopting preventive measures on malaria parasitemia among pregnant women in Kaduna state, Nigeria


1 Department of Medical Laboratory Services, University of Abuja Teaching Hospital, FCT Abuja, Nigeria
2 Department of Medical Microbiology and Parasitology, Lagos State University Teaching Hospital, Ikeja, Nigeria
3 Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
4 Department of Medical Laboratory Science, University of Maiduguri, Maiduguri, Nigeria
5 Institute of Human Virology, Abuja, Nigeria
6 Department and Obstetric and Gynaecology, University of Abuja Teaching Hospital, FCT Abuja, Nigeria

Date of Submission07-Aug-2016
Date of Acceptance05-Dec-2016
Date of Web Publication15-Feb-2017

Correspondence Address:
Idris Abdullahi Nasir
Department of Medical Laboratory Services, University of Abuja Teaching Hospital, PMB 228 Gwagwalada, FCT Abuja
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1687-1693.200151

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  Abstract 

Background
There are several malaria preventive measures. The availability of a particular method does not guarantee its adherence and effective usage. This eventually may not provide the desired results for the fight against malaria. Pregnant women are at higher risk of contracting malaria, and therefore it is necessary that they should be protected against the infection.
Objective of the study
This cross-sectional study investigated the significant roles of various preventive measures against malaria infection among pregnant women attending four selected secondary health facilities in Kaduna state, Nigeria.
Materials and methods
Blood samples were collected from 353 pregnant women attending selected hospitals. Malaria parasite microscopy was conducted on the basis of standard protocols. Structured questionnaires were used to obtain data with regard to subject knowledge and practice of preventive measures against malaria.
Results
Out of the 353 subjects tested, 79 (22.4%) had malaria parasitaemia. One hundred and fifteen (32.6%) subjects used no preventive measure, 45 (12.7%) used sulfadoxine-pyrimethamine prophylaxis, 53 (15.0%) used insecticide treated nets (ITNs), 72 (20.4%) used indoor insecticide house spray, while 68 (19.3%) used > 1 preventive measures. Out of the 79 subjects infected with malaria, 57 (72.2%) do not know how to prevent malaria, while 22 (27.8%) had prior knowledge of malaria prevention. Highest cases (41 [51.9%]) of malaria parasitaemia were recorded in women with no knowledge of preventive measures during pregnancy, while women who used > 1 measures have the least cases (5 [6.3%]) of malaria parasitaemia. There was statistical association between the use of preventive measures and decreased malaria parasitaemia (P < 0.0001).
Conclusion
Findings from this study revealed that there is need for more sensitization campaigns on available malaria preventive measures. Also, the combination of preventive methods should be considered by pregnant women in order to minimize their chances of acquiring malaria.

Keywords: malaria, preventive strategies, prophylaxis, risk factors


How to cite this article:
Nasir IA, Jelili M, Dangana A, Musa PO, Babayo A, Usman Y, Ugboaja NB, Zakari MM. Effects of adopting preventive measures on malaria parasitemia among pregnant women in Kaduna state, Nigeria. Al-Azhar Assiut Med J 2016;14:126-9

How to cite this URL:
Nasir IA, Jelili M, Dangana A, Musa PO, Babayo A, Usman Y, Ugboaja NB, Zakari MM. Effects of adopting preventive measures on malaria parasitemia among pregnant women in Kaduna state, Nigeria. Al-Azhar Assiut Med J [serial online] 2016 [cited 2017 Jun 28];14:126-9. Available from: http://www.azmj.eg.net/text.asp?2016/14/3/126/200151


  Introduction Top


It has been estimated that 55 million pregnancies occur in areas with stable Plasmodium falciparum transmission [1]. Acquiring malaria in pregnancy can have severe consequences for both the mother and the child. Malaria in pregnancy remains a public health problem in Nigeria and other developing nations. It causes maternal anemia and adversely affects birth outcomes, leading to low birth weight, abortions, and still births [2].

In recent times, Nigeria has made great strides in addressing the prevention and control of malaria in pregnancy. However, recent cross-sectional studies show wide disparities in malaria control activities across various cities in Nigeria [2],[3],[4]. Considering the closeness between a mother and child, effective measures put in place to protect the mother from malaria could also protect the child, and hence reduce the morbidity and mortality related to malaria. The use of these measures in pregnancy may not warrant independent programming, but if used in combination to provide a range of prenatal services the incremental cost may be cost effective [5].

In view of the fact that each of these preventive measures has its advantages and disadvantages, their use in isolation may not provide the necessary results in the fight against malaria. Nevertheless, it is essential that mothers have necessary knowledge about the use and treatment of nets, have authorized and safe indoor insecticide sprays at their disposal when in need, and should be highly aware of the importance of the use of other malaria-prevention measures [6].

Another key intervention for controlling malaria and its effects during pregnancy is the administration of intermittent preventive treatment [7]. This consists of a complete therapeutic course of antimalarial medicine given to pregnant women at routine prenatal visits, regardless of whether they are infected with malaria or not. Intermittent preventive treatment reduces incidences of maternal malaria episodes as well as maternal and placental parasitemia. Therefore, the WHO recommends intermittent preventive treatment with sulfadoxine-pyrimethamine (SP) in areas with moderate-to-high malaria transmission in the African subregion [8]. The objective of this study was to determine malaria-prevention methods used by pregnant women and how well these methods prevented them from contracting malaria.


  Materials and methods Top


Study area

This study was carried out between 16 February and 28 April 2015, at antenatal clinics of General Hospital Kawo, Yusuf Dantsoho Hospital, Gwamna Awon Hospital, and Barau Dikko Hospital, Kaduna state, Nigeria. Kaduna lies at a latitude of 10°20′ north and longitude of 7°45′ east and covers an area of 45 711.2 km2. It has a population of 6 113 503 (2006 census figures) and a population density of 130 people per square kilometer. It accounts for 4.3% of Nigeria’s total population. Kaduna was created on 27 May 1967, out of the former Northern region by the then regime of General Murtala Mohammed. Katsina state was created out of it during the state creation exercise of 1987. Its capital is Kaduna. Kaduna state is located at the center of Northern Nigeria. It has a political significance as the former administrative headquarters of the north during the colonial era. The state shares boundaries with Niger state to the west, Zamfara, Katsina, and Kano states to the north, Bauchi and Plateau states to the east, and FCT Abuja and Nassarawa states to the south.

Study design and subjects

This cross-sectional study involved 353 randomly selected pregnant women who presented for antenatal consultations in the four health institutions of Kaduna state, Nigeria. A questionnaire was given to individual pregnant woman. This was either self-administered or filled in by a trained interviewer for those who could neither read nor write. The questionnaire was designed to obtain information on sociodemographic data, knowledge, and utilization of prevention measures against malarial infection. Information was collected on age, occupation, level of education, age during pregnancy, utilization of SP, use of indoor insecticide sprays, and mosquito bed nets.

Ethics approval

Administrative and ethics clearances were obtained from the ethical research committee of Kaduna State Ministry of Health, Kaduna state, Nigeria. Consent forms were issued, and in some cases read out and explained to the subjects. The objective and procedure of the study was explained to the participants, and those who accepted to be part of it provided signed consent.

Sample size

We had a calculated a sample size of 383 on the basis of a study by Fana et al. [9] who reported a prevalence of 41.6%, and a total of 353 pregnant women completed the study. Some refused to participate.

Malaria microscopy

About 2 ml of blood was collected from a peripheral vein into an EDTA-containing bottle for preparation of thick and thin blood films. Two glass slides were labeled for each participant. A drop of blood was then placed on a clean, grease-free glass slide and allowed to dry. For thick films, a drop of blood was dropped at the center of a clean, grease-free microscope slide to cover an area of 15 mm in diameter. The smears were allowed to air dry after which they were flooded with 10% Giemsa stain, and then allowed to stay for 10 min before the stains were washed off with water. The thick films were used to detect the presence of malaria parasites in the blood samples. Parasite species and morphology were determined by microscopic examination of the thin films, which were also performed with 10% Giemsa stain for 5 min. Microscopic examination of the stained slides was performed using oil immersion objective lens (×100 objective).

The parasite species was identified by preparing thick and thin blood films on microscope slides using Giemsa staining techniques, as described by Cheesebrought [10].

Statistical analysis

Data were analyzed using SPSS version 20 (SPSS Inc., Chicago, Illinois, USA). Descriptive statistics were performed on variables, whereas the Pearson χ2-test was used to assess the association between utilization of malaria prevention methods and malaria parasitemia. Statistical significance was set at P-value less than 0.05.


  Results Top


In total, 353 pregnant women in various trimesters were recruited for the study, aged between 17 and 44 years, with a mean age of 22.45±6.84 years. Of the recruited subjects, 76.8% were multigravidae, 2.0% were in their first trimester, 62% were in their second trimester, and 36.0% in the third trimester. The majority of pregnant women were housewives (51.6%) ([Table 1]). All the malaria-positive cases were that of P. falciparum only. Out of the 353 subjects tested, 79 (22.4%) had malaria parasitemia. A total of 115 (32.6%) subjects used no preventive measures, 45 (12.7%) used SP prophylaxis, 53 (15.0%) used insecticide-treated nets (ITNs), 72 (20.4%) used indoor insecticide house spray, and 68 (19.3%) used more than one preventive measures. Out of the 79 subjects infected with malaria, 57 (72.2%) did not know how to prevent malaria, whereas 22 (27.8%) of them had previous knowledge of malaria prevention. The highest number of cases [41 (51.9%)] with malaria parasitemia was recorded among women with no knowledge of preventive measures during pregnancy, and women who used more than one measure had the least cases [5 (6.3%)] of malaria parasitemia. There was statistical association between use of malaria-preventive measures and malaria parasitemia (P=0.011) ([Table 2] and [Figure 1]).
Table 1 Sociodemographic characteristics of the subjects

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Table 2 Prevalence of malaria parasitemia across preventive measures adopted by pregnant women

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Figure 1 Distribution of malaria parasitemia based on previous knowledge of preventive measures.

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  Discussion Top


The prevalence of malaria parasitemia observed in this study was 22.4%. The observed prevalence of malaria parasitemia could be due to low coverage of SP in the study area, which was below 16% for the recommended two doses, or perhaps due to increased SP resistance. When compared with the 1990s, the relatively lower prevalence rate of malaria observed among ANC attendees in this study could be a result of increased use of malaria-prevention tools such as ITNs and insecticidal residual sprays [11]. The result of this study differs from that of Ogbu et al. [12] who recorded a higher malaria prevalence of 38.8%. This may be because of the fact that the study was carried out during the dry season alone when infection rate was high.

In this study, 53 (15.0%) pregnant women reported to own ITNs and slept under them the previous night before coming to ANC; this number is very low when compared with other studies [9],[13]. The reasons for this observation could include lack of money to buy nets, lack of availability of nets during the distribution by public health campaigns, and dislike for mosquito nets.

In this study, the risk factors found to be significantly associated with P. falciparum malaria included use of SP prophylaxis and ITNs. Despite the low coverage of SP, we found it confers some protection against malaria. This observation was also seen in other studies [14]. This could be a spurious effect because overall malaria prevalence has gone down, and in this study the prevalence of parasitemia was relatively low. Even though a few subjects used ITNs, women who used them were effectively covered against malaria. ITNs effectively reduce human–mosquito contact, and thus reduce malaria transmission among those who use them. The ongoing distribution of ITNs among pregnant women attending ANC in Nigeria should be sustained and be made free of charge. This will significantly help reduce the transmission of malaria.


  Conclusion Top


This study shows that indoor insecticide house spray and bed nets are the most commonly used methods of malaria prevention by pregnant women either singly or in combination. Findings from this study revealed that there is need for more sensitization campaigns on available malaria-preventive measures. In addition, combination of prevention methods should be considered by pregnant women in order to minimize chances of contracting malaria.

Acknowledgements

The authors appreciate Mr Adamu Idris for providing technical input for this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Dellicour S, Tatem AJ, Guerra CA, Snow RW, ter Kuile FO. Quantifying the number of pregnancies at risk of malaria in 2007: a demographic study. PLoS Med 2010; 7:e1000221.  Back to cited text no. 1
    
2.
Muhammad HU, Giwa FJ, Olayinka AT, Balogun SM, Ajayi IO, Ajumobi . Malaria prevention practices and delivery outcome: a cross sectional study of pregnant women attending a tertiary hospital in northeastern Nigeria. Malar J 2016; 15:326.  Back to cited text no. 2
    
3.
Ogbu GI, Aimakhu CO, Anzaku SA, Ngwan S, Ogbu DA. Prevalence of malaria parasitaemia among asymptomatic women at booking visit in a tertiary hospital, North central Nigeria. J Reprod Biol Health 2015; 3:1.  Back to cited text no. 3
    
4.
Alli LA, Isah AY, Jamda MA, Adesokan AA. Use of intermittent preventive treatment for malaria among pregnant women in Kubwa, Abuja, Nigeria. Int J Trop Dis Health 2013; 3:339–345.  Back to cited text no. 4
    
5.
Steketee RW, Wirima JJ, Campbell CC. Developing effective strategies for malaria prevention programs for pregnant African women. Am J Trop Med Hyg 1996; 55(Suppl):95–100.  Back to cited text no. 5
    
6.
Olayemi SO, Oreagba IA, Mabadeje AFB. Knowledge and practice of the use of insecticide treated nets among mothers in Lagos Nigeria. Nig Qt J Hosp Med 2004; 14:181–184.  Back to cited text no. 6
    
7.
WHO Evidence Review Group. Intermittent preventive treatment of malaria in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP). Geneva: World Health Organization; 2012. 1–17.  Back to cited text no. 7
    
8.
World Health Organization. A strategic framework for malaria prevention and control during pregnancy in the African region. Brazzaville: World Health Organization, Regional Office for Africa; 2004.  Back to cited text no. 8
    
9.
Fana SA, Bunza MDA, Anka SA, Imam AU, Nataala SU. Prevalence and risk factors associated with malaria infection among pregnant women in a semi-urban community of north-western Nigeria. Infect Dis Poverty 2015; 4:24.  Back to cited text no. 9
    
10.
Cheesebrought M. Medical laboratory for tropical countries. In: Cheesbrough M. Microbiology. London: Tropical Health Technology, Gillies and Dodds Publishers; 1992. 2. 234.  Back to cited text no. 10
    
11.
West PA, Protopopoff N, Wright , Kivaju Z, Tigererwa R, Mosha FW et al. Indoor residual spraying in combination with insecticide-treated nets compared to insecticide-treated nets alone for protection against malaria: a cluster randomised trial in Tanzania. PLoS Med 2014; 11:e1001630.  Back to cited text no. 11
    
12.
Ogbu GI, Aimakhu CO, Ajen Anzaku S, Ngwan S, Ogbu DA. Prevalence of malaria parasitaemia among asymptomatic women at booking visit in a tertiary hospital, North central Nigeria. J Reprod Biol Health 2015; 3:1.  Back to cited text no. 12
    
13.
Olukemi OT, Adebola EO, Olusegun OA. Utilisation of malaria preventive measures during pregnancy and birth outcomes in Ibadan, Nigeria. BMC Pregnancy Childbirth 2011; 11:60.  Back to cited text no. 13
    
14.
Shulman CE, Dorman EK. Importance and prevention of malaria in pregnancy. Trans R Soc Trop Med 2003; 97:30–35.  Back to cited text no. 14
    


    Figures

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    Tables

  [Table 1], [Table 2]



 

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